FEE SCHEDULE

Guide to understand our Medical fees

Medicare & Health fund

Medicare and Health funds share the same goal of trying to make healthcare more affordable by covering a substantial portion of your health expenses. When you are receiving good medical care, there is a lot of effort and resources put in to make this possible and to ensure an exceptional standard of care. This includes professional training & regular accreditations; equipment & pharmaceutical research, trials and audits; legal, accounting and record keeping etc. This huge undertaking and responsibility invariably drive up the cost of medical care, but our healthcare system is not only considered to be top class by international standard, it is also very much accessible by the community because of our robust healthcare system and our Governments' (both the Commonwealth and State) relentless support in ensuring our healthcare remain as one of the nation’s top priorities.

Click read more to understand Medicare and Health fund better.

Medicare is a Commonwealth Government of Australia’s initiative which is currently being administered by the Department of Human Services on behalf of the Department of Health and Ageing (DoHA). It provides health cover for Australian residents / citizens in various models, from providing free medical treatment in public clinics & hospitals to substantially subsidized treatment in private clinics & hospitals. The Commonwealth Government determines the amount of rebates for each service and procedure, and the terms & conditions in which you are qualified for such rebate. This information is published in the Medicare Benefits Schedule (MBS) which can now be accessed via MBS online. The Government also provides further assistance through the Medicare Safety Net (MSN) for those who are eligible.

For those services which are listed in the MBS, Medicare generally subsidizes 75% of the MBS fee for hospital-based (i.e. inpatient) care and 85% for clinic-based (i.e. outpatient) care. Private health funds generally cover the 25% and 15% gap respectively. It is pertinent to note that not all services attract Medicare rebates. If a service is not listed in the MBS, no Medicare rebate is rendered. Moreover, private health funds generally do not cover the cost of non-MBS-listed services.

In addition, Medicare does not cover private hospital admission, theatre fee and other services (unless listed in the MBS). If you wish to access these services, you would have to either cover the cost yourself (i.e. self-funding) or get a health fund which can provide some / all level of cover (also termed as health fund benefits). Although health funds provide benefits covering services like consult, procedures and ultrasound scans, they are limited to hospital-based (i.e. inpatient) care only, not clinic-based (i.e. outpatient) care which the Commonwealth Government is currently exploring the notion of getting private health funds to cover for these outpatient services.

Choosing the right health fund is very important but can be daunting as there are many health funds / insurances available and many options / packages to choose from to suit your particular needs. You may try to check the websites of the various health funds or go to independent sources like Choice to gain greater knowledge in this topic. Generally, health funds would try to reduce your gap (i.e. out-of-pocket expenses) between your actual service cost and Medicare rebates, by providing you benefits as determined by your insurance policy. The level of cover (or amount of benefits) you receive from your health fund is stated in your health fund policy / package, and it is therefore important that you understand the terms and conditions of your policy, especially on areas like what treatments are covered; what restrictions apply e.g. the waiting period for pre-existing conditions; whether there is special scheme which attracts more benefits like Gap Cover Scheme, Medical Gap Scheme or equivalent; and of course, the overall benefits you are expected to receive.

If you are not a Medicare card holder, you are not eligible for Medicare rebates and also not bound by Medicare rules but your care is still maintained at a high professional standard in accordance to the Medical Board of Australia and respective specialist colleges like the Royal Australia and New Zealand College of Obstetrics and Gynaecology (RANZCOG). Some countries have reciprocal arrangement with Medicare Australia, in which case, you may be entitled to the appropriate rebates for medical services. Please check with your country’s health policy and your overseas health fund, and advise us accordingly.

Our fee schedule

Our fee schedule is structured to enable a sustainable specialist service which strives to deliver a high professional standard, and to provide you a personalised and holistic care, not a corporate- or budget-style care model. This is driven by our philosophy that every individual has his/her unique set of characteristics, circumstances and challenges; and that health, fertility and childbirth are amongst our most important living assets not to be taken granted of.

Our fee schedule is guided by the Australia Medical Association (AMA), Medicare Australia, and BUPA’s Medical Gap Scheme. Because Medicare and Health funds determined under what circumstance you are eligible for rebates & benefits, we have attempted to simplify this process by categorising our fee schedule into five areas: Consult; Ultrasound; Procedures; Fertility Care; and Pregnancy Care. Each of these areas are explained in our Fee Schedule.

Trying to provide a detailed fee structure can be a difficult task as there are many factors influencing your final payment. Whilst we aim to provide you a transparent fee schedule and a total estimate of billings, your out-of-pocket expenses may vary based on the services and treatment you received; your health cover policy; Medicare rebate; Medicare Safety Net benefits; and services from other professionals whose fees are beyond our control. Despite the billing complexities of our private healthcare system, we will always try to give you a clear explanation of our fee schedule, address any enquiry you may have, and assist you in working out your estimated billings. You can usually work out your actual out-of-pocket expenses after receiving all your claims from your health fund, Medicare and tax return.

As said, we generally follow the fee schedule recommended by the Australian Medical Association which has worked out what a fair payment should be based on the amount of time and expertise needed to provide such service. Having said this, we are flexible in lowering our fees for those participating in Co-payment and are eligible to access their health fund’s Medical Gap Scheme or equivalent. In other words, we are considered by the health funds as a Known Gap practice. Scroll down this page on Fee Schedule to Proceduresto understand how Co-payment scheme could help reduce your out-of-pocket expenses.

As our practice focuses on patient care more so than competing for a budget service, we are not able to keep track with what other practices are charging. If you have a formal quote from other practices which you think is more cost competitive, we can consider matching the quote if deemed reasonable. As a general advice, you are encouraged to seek independent advice from Medicare, your health fund, the hospital, and other specialists / parties involved before deciding on which proposed treatment option to take; and to always take your time to consider your options carefully. Remember, our friendly staff is always more than happy to assist you in this regard if you have any enquiry.

Focusing on cost per se may not give you the overall perspective on how you should choose your treatment options. Cost effectiveness is a better measure because it takes into account the real benefits you gain per unit cost. Ways you can increase your treatment’s cost effectiveness are:

Only have treatment which you believe would be most suitable to your current & future needs after close consultation with your specialist

Having multiple items done on the same day:

Cost saving from not having to go through multiple hospital admissions and anaesthetics; and

Time saving from not needing another period of recuperation

Choose a suitable health policy cover: different policy gives different level of benefits; and generally speaking, the level of benefits you get is largely influenced by your premium. Although a top cover with no excess usually gives more benefits, it also comes with a higher premium and hence may result in considerable financial burden. A more balanced approach would be to go for a more affordable premium but at the same time, be prepared to pay an excess and gap should you need treatment. Do your research and seek an independent professional advice.

Register yourself with Medicare Safety Net. By paying your treatment package in advance, you may reach your threshold sooner and become eligible for additional benefits from Medicare.

Medicare Benefits Schedule (MBS): cost for each procedural item as suggested by the Australian Commonwealth government. For hospital-related treatment, Medicare rebates cover 75% of the MBS fee, while most health funds cover at least 25% of the MBS fee. For out-of-hospital treatment, Medicare rebates cover 85% of the MBS fee, but most health funds do not cover any.

Medicare Safety Net provides you with financial assistance for out-of-pocket expenses for out-of-hospital MBS services once you meet your Medicare Safety Net threshold. Your eligibility for this financial assistance will last for the rest of the calendar year. The benefit you get can range from getting 100% of MBS fee to 80% of your out-of-pocket expenses (up to the EMSN benefit cap). Please ring 132011, check out their website or visit your local Medicare office for registration and further information.

Australian Medical Association (AMA) rate: fee schedule for each procedural item as deemed appropriate and fair by the AMA.

Gap is the difference in procedural cost between our fees and the total amount you received from your health fund and Medicare. This Gap will constitute your out-of-pocket expenses. For more information on why there is a gap, go to our FAQ section.

Gap Cover Scheme (GCS) or equivalent: In an attempt to reduce the gap, various health funds have come up with their own set of fees for each procedural item which they termed as Gap Cover Scheme (by AHM), Medical Gap Scheme (by BUPA), Access Gap Scheme (by AHSA) etc. These schemes generally provide a benefit higher than the MBS fee. Nonetheless, each health fund sets its own rules dictating when the scheme is applicable. We participate in those schemes which allow Co-payment as a way to reach a fair compromise between the fees proposed by the AMA and the fees by the health fund.

Co-payment (term interchangeable with Known Gap) is the agreed out-of-pocket expense before we access your health fund’s GCS (or equivalent) on your behalf. Success in this process could essentially reduce your overall gap payment down to amount of your Co-payment.

Consults

Your face-to-face meeting with the specialist is termed as a consult or attendance. This allows you to discuss your concerns and to explore what management options available and appropriate for you. Before a diagnosis is made and management options discussed, your specialist may gather your medical history and records, organise relevant tests, review the pathology reports and imaging films you bring in, and examine you appropriately. Because we appreciate that every individual requires different level of attention and care, we are now offering a flexible fee schedule based on your requirement. We can offer you an introductory session at no gap for those eligible for Medicare rebates, as well as a more comprehensive session to cover complex issues at a time-based rate. This way, you have the opportunity to talk to our specialist and have the flexibility to organise your appointment schedule based on your needs, rather than a one-size fits all model.

If you have a formal quote from other practices which you think is more cost competitive, we can consider matching the quote if deemed reasonable.

Your first consult may take up to 15-60min, while subsequent visits usually take about 15-30min which can be extended if needed. The fee for your consult is dependent on how complex your issue(s) and how long your appointment takes. You would be advised of the fee prior to your consult. Attending partner (under fertility care as a couple) usually incur no gap. This fee schedule is applicable for those with a valid Medicare card. Our fee schedule is structured to give you the opportunity to enjoy the flexibility to book your session based on your need and budget.

It is important to highlight that Medicare rebates only differentiate the consult into first consult and subsequent consults, and also differentiate it based on the type of care, e.g. pregnancy-related or not. According to Medicare Benefit Schedule, you will receive a higher Medicare rebate for first consult compared to subsequent consults. As our fee schedule is essentially flexible to cater for your needs, your out-of-pocket expenses (or gap) would therefore be influenced by how long your booked session takes. As a result of Medicare's fixed rebates per attendance, you will end up receiving more rebates with increasing number of attendance, thereby lowering your gap if you choose to organise your care into multiple short consults. In addition, your gap can be reduced further if you qualify for benefits from the Medicare Safety Net.

It is also pertinent to know that most private health funds currently do not provide benefits for outpatient / clinic-based services. In other words, the cost incurred to you for consults or clinic-based procedures would more or less be the same even if you do not have private health cover.

To be eligible for Medicare rebates, you must have a current Medicare card, a referral letter by a Medicare-recognised health-provider like your family doctor, nurse practitioner, midwife and specialist, and meet all the Medicare rules.

Ultrasound Scan

We offer a combined clinical consult and ultrasound scan to make your visit convenient and rewarding. This unique service may reduce your time doing the run around, cut-down the delay in getting your results and smoothen your treatment process. For routine antenatal consult, we offer a complimentary ultrasound scan to screen for any unforeseen problems like abnormal foetal position and well-being, which will give you a piece of mind, not mentioning the excitement of seeing your baby in action. Click here to view a video clip of an antenatal ultrasound scan.

Our ultrasound scan fee has remained unchanged for the past 5 years.

Click read more for more detail on our ultrasound scan fee schedule.

A comprehensive pelvic ultrasound scan would cost $ 210 while twin / multiple pregnancy scan $ 270. If you choose the combined service (i.e. consult and scan on the same visit), you would receive a $ 30 discount off your usual scan fee.

Procedures

Any form of surgery is classified as a procedure. We generally refer to the fee schedule as recommended by the Australian Medical Association (AMA) which has worked out what a fair payment should be based on the amount of time and expertise needed to provide such treatment.

Click read more for further explanation about our Procedure fees.

Medicare rebates for outpatient/clinic procedures are different from inpatient/hospital-based procedures, i.e. at 85% of the MBS schedule for the former, and at 75% for the latter.

Your health fund would generally cover inpatient procedures at 25% of the MBS schedule, but can cover you more if your treatment is eligible for Gap Cover Scheme or equivalent. If you do not have private health cover, you can still consider self-funding or obtain financial assistance for hospital-based procedures.

For clinic-based procedures, most health funds currently do not provide any cover, in which case the procedure cost incurred is no different whether you have a health fund or not.

We are flexible in reducing your treatment fees if you agree to participate in Co-payment and are eligible to access their health fund’s Gap Cover Scheme or equivalent. Refer to the chart below which gives you an example illustrating how Co-payment scheme helps reduce your gap.

It is pertinent to note that not every procedure attracts Medicare rebates or cover by your health fund. Because your out-of-pocket expenses may vary based on the surgery (type and number of MBS items); your health cover policy; Medicare rebate; Medicare Safety Net rebate; and services from other professionals whose fees are beyond our control, we shall give you a clear explanation of our fee structure which includes an estimated total billing, and may request for a deposit payment before we go ahead with your planned treatment. After treatment, we shall work out your total procedural fee and refund you any unused portion of the deposit. You can work out your actual out-of-pocket expenses after receiving all claims from your health fund, Medicare and tax return.

If you have a formal quote from other practices which you think is more cost competitive, we can consider matching the quote if deemed reasonable.

Fertility Care

Not every couple having difficulty trying to get pregnant needs to have IVF treatment. Our approach is to provide you a comprehensive assessment to determine the cause(s) of your problem followed by discussion of which treatment you need or acceptable to you. In other words, we customise your management according to your unique condition and circumstances. You will start with having consult appointments, and may go on to have an ultrasound scan, diagnostic procedure and/or fertility treatments. The actual cost will vary individually and ultimately by which process you achieve a pregnancy and have a baby.

Click read more for more detail on our Fertility Care fee schedule.

We have attempted to itemise the costs involved in providing you a comprehensive fertility care but the actual cost you shall incur depends on what treatment you require / choose to have and how soon you achieve your goal of having a baby. Some individuals may achieve their goal after having an initial assessment, costing them less than $ 50, while some may require multiple cycles of fertility treatment costing over $ 1,000-3,000 for each cycle, and may or may not achieve their goal.

After having a proper assessment, you will have a frank discussion with your specialist about your fertility prospect, what fertility-enhancing treatment you need, and an estimated budget you should prepare. It is important to remember that the journey of having a baby can be very emotionally driven and financially draining, but the outcome can be very fulfilling especially if you have careful consideration and planning, and know how much and how long you are prepared to invest. Like building your dream home, you cannot simply sign up a plan and expect your dream home to come true without due care of finding the right builder who will listen to you, have your best interest in mind, see you through the whole process, and feel passionate to help you achieve your dream. And because the ability of having a baby is influenced by many factors, there is no guarantee that any fertility treatment would work for you. We still need a sparkle of miracle to see your baby dream comes true.

If you have a formal quote from other practices which you think is more cost competitive, we can consider matching the quote if deemed reasonable.

Pregnancy Care

Our comprehensive pregnancy care involves a series of consults, step-by-step guide to good antenatal support and monitoring, on-call support for any urgent situations, labour management & delivery, and postnatal care. Your first consult includes comprehensive assessment and planning, and the session usually takes up to 60min. Thereafter, your review visits usually take about 15min.

For routine antenatal consult, we offer a complimentary ultrasound scan to screen for any unforeseen problems like abnormal foetal position and well-being, which will give you a piece of mind, not mentioning the excitement of seeing your baby in action.

Click read more for an in-depth explanation of our Pregnancy Care fee schedule.

When you attend our clinic, our friendly staff will take you through the pregnancy services and the associated cost, Medicare rebates and Health fund benefits. It is not unusual for most patients to take a while to understand the Australian complex healthcare system but we will endeavour to assist you in this regards.

Pregnancy Care Program (also known as Pregnancy Planning & Management, or PPMF) is to cover ongoing management throughout your entire pregnancy including birth plan preparation, hospital booking, after hour phone advice and other administrative support. More detailed explanation can be found in our FAQ section. PPMF is payable once only for a pregnancy when you are over 12 weeks gestation and ready to register in our Pregnancy Care Program. You may claim Medicare rebates for this service once your pregnancy has progressed beyond 28 weeks gestation.

Unless specified by Medicare under item 16590, all other fees for consult / attendance, ultrasound scans, procedures etc will not be covered under PPMF. Details of all these fees will be provided prior to providing these services.

Medicare rebates for birth / delivery are essentially divided into two groups. One is an uncomplicated birth which can be a normal vaginal delivery, an instrumental delivery or an elective Caesarean section, as long as there is no event or condition as described by Medicare as complicated labour and delivery. Complicated labour and delivery as defined by Medicare includes conditions like multiple pregnancy, recurrent antenatal bleeding, low birth weight, diabetes, hypertension, trial of vaginal birth after previous Caesarean section, prolonged labour, foetal distress etc.

The amount for delivery and other obstetric procedures as listed under Medicare Benefit Schedule (MBS) are essentially the rebates you would receive from Medicare. Your out-of-pocket expenses for delivery will be influenced by your health cover policy. However, the out-of-pocket expenses can be reduced if you are eligible to participate in some health fund's Gap Cover Scheme (or equivalent) and we can help you determine your eligibility during your clinic attendance. If you are not eligible or do not have private health fund cover, the fees for any obstetric procedure will be in accordance with our fee schedule as recommended by the Australian Medical Association (AMA).

You may receive invoices from other professionals like the anaesthetist, surgical assistant and paediatrician, and we encourage you to contact them directly for their quote.

As different health funds have different policies governing your benefits and entitlements, it is not possible for us to give you an accurate estimate of your final out-of-pocket expenses / gaps. Our friendly staff will endeavour to explain our fair & transparent fee schedule to assist you.

If you have a formal quote from other practices which you think is more cost competitive, we can consider matching the quote if deemed reasonable.

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This Information Section is intended to provide general information and advice to the general public as well as those who have attended our clinic. The information should never be relied upon as a substitute for proper assessment with respect to the particular circumstances of each case and the needs of each individual.

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